Vanderbilt-West Virginia (VWV) Collaborative: A HOPE Consortium Clinical Center

超过50%的成人中心血液透析患者经历并接受非癌症慢性疼痛治疗 （NCCP）。治疗方法通常是复杂的，因为疼痛本身的潜在病因导致了疼痛的发生。 身体和心理上的缺陷。缺乏研究证据， 血液透析，以指导药物治疗的最佳方法或其他创新策略，以支持 以患者为中心的综合疼痛管理，以减少药物治疗的并发症， 总体发病率。作为血液透析阿片类药物处方努力（HOPE）的临床中心成员 该提案的总体目标是与不同的利益相关者合作， 开展多中心试验，评估减少阿片类药物剂量、改善生活质量和 在接受中心血液透析的成人中进行疼痛管理的护理经验。我们提出 特别是进行一个实用的平行臂试验，以测试增加12周互动视频的影响， 认知行为疗法（IV-CBT）干预计划，与CDC指南一致性共享 决策（SDM）的NCCP药物治疗管理。具体目标如下：目标1 一项多中心随机试验，在15个月内接受IV-CBT和SDM与SDM单药治疗;患者将 在基线、12周、9个月和15个月时进行评估;目标2调查和描述障碍， 在患者、临床医生和透析工作人员中实施IV-CBT和SDM的促进者;目标3 创建研究者和透析机构的协作网络，以便高效、快速地招募受试者 并传播成功的策略，以优化透析中的疼痛护理。在目标2中，申请人将 调查与实施《综合执行框架》的干预措施有关的因素 研究（CFIR），并为一个执行工具包提出建议，以指导未来的传播 每一个战略。这项研究是创新的，因为：i）它试图改变目前的临床实践， SDM始终集成到疼痛管理临床实践中; ii）利用远程医疗支持 心理和情感支持策略，以培养动机和维持多模态策略 用于慢性疼痛护理;以及iii）在具有多种发病率的患者的真实世界环境中进行的试验，这些患者定期 从试验中排除，是新颖的，具有更大的外部效度。结果预计将有一个重大的 积极影响，因为它们将增加临床理解并强调多学科的重要性 慢性疼痛管理策略，以应对改善患者发病率和 生活质量在一个高度普遍和复杂的护理领域。

More than 50% of adult in-center hemodialysis patients experience and are treated for non-cancer chronic pain (NCCP). The treatment approach is often complex as the underlying etiology of the pain itself contributes to a combination of physical and psychological impairments. There is a paucity of research evidence specific to hemodialysis to guide the optimal approaches to pharmacotherapy or other innovative strategies to support patient-centered comprehensive pain management to reduce complications of pharmacologic therapy and morbidity overall. As a clinical center member of the Hemodialysis Opioid Prescription Effort (HOPE) Consortium, the overall objective of this proposal is to collaborate with diverse stakeholders to design and conduct a multi-site trial evaluating innovative strategies to reduce opioid dosing, improve quality of life and experience with care specific to pain management among adults receiving in-center hemodialysis. We propose specifically to perform a pragmatic parallel arm trial to test the impact of adding a 12-week interactive video cognitive behavioral therapy (IV-CBT) intervention program, compared to CDC guideline concordant shared decision-making (SDM) for NCCP pharmacotherapy management. The specific aims are: Aim 1 Conduct a multi-site randomized trial to receive IV-CBT and SDM versus SDM alone over 15 months; patients will be assessed at baseline, 12 weeks, 9 months and 15 months; Aim 2 Investigate and describe barriers and facilitators of the implementation of IV-CBT and also SDM among patients, clinicians and dialysis staff; Aim 3 Create a collaborative network of investigators and dialysis facilities for efficient and swift subject recruitment and for dissemination of successful strategies to optimize pain care in dialysis. In Aim 2, applicants will investigate factors related to the interventions applying the Consolidated Framework for Implementation Research (CFIR), and develop recommendations for an implementation toolkit to guide future dissemination of each of the strategies. The research is innovative because: i) it seeks to shift current clinical practice where SDM is consistently integrated into pain management clinical practice; ii) telemedicine is leveraged to support psychological and emotional support strategies to foster motivation and maintenance of multimodal strategies for chronic pain care; and iii) a trial in real-world settings of patients with multi-morbidity, who are regularly excluded from trials, is novel and has greater external validity. The results are expected to have a major positive impact as they will increase clinical understanding and underscore the importance of multidisciplinary chronic pain management strategies in tackling on the significant challenge of improving patient morbidity and quality of life in a highly prevalent and complex area of care.